Perforation during colonoscopy in endoscopic ambulatory surgical centers
Perforation during colonoscopy in endoscopic ambulatory surgical centers
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DOI：
10.1067/s0016-5107(03)01890-x
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发表时间：
2003-10-01
影响因子：
7.7
通讯作者：
Winker, CK
中科院分区：
文献类型：
--
作者：
Korman, LY;Overholt, BF;Winker, CK
背景资料：穿孔作为结肠镜检查的并发症，估计发生在0.01%至0.3%的手术中，但在门诊环境中的发生率尚不清楚。本研究确定了在一个网络内的内镜门诊手术centers.Methods：共116,000结肠镜检查的穿孔发生的数量进行了一个网络内的45个内镜门诊手术中心在美国在1999年。所有确定的穿孔报告给网络的临床主任和审查小组3 gastroenterologist.Results：有37（0.03%）穿孔，27名女性和10名男性。患者中位年龄为75岁（范围39-87岁）; 18例患者（49%）患有憩室疾病，20例（54%）有盆腔或结肠手术史。24例（65%）手术为诊断性手术，13例（35%）为治疗性手术。最常见的穿孔部位是乙状结肠（62%）;其次是升结肠（16%）;盲肠、横结肠和脾曲（11%）;以及直肠、吻合口或未知部位（11%）。诊断时间从即刻到72小时不等（29 ± 1小时）。所有患者均住院治疗; 35例（95%）接受剖腹探查术，2例（5%）接受保守治疗。无一例死亡。结论：在有手术史或憩室病史的老年女性中，在门诊内镜手术中心进行的手术中报告的穿孔最常发生在诊断性结肠镜检查期间。内窥镜门诊手术中心报告的穿孔并不常见。
Background: Perforation as a complication of colonoscopy is estimated to occur in 0.01% to 0.3% of procedures, but the frequency in ambulatory settings is unknown. This study determined the number of perforations occurring within a network of endoscopic ambulatory surgery centers.Methods: A total of 116,000 colonoscopies were performed within one network of 45 endoscopic ambulatory surgery centers in the United States during 1999. All identified perforations were reported to the network clinical director and reviewed by a panel of 3 gastroenterologists.Results: There were 37 (0.03%) perforations; 27 in women and 10 in men. Median patient age was 75 years (range 39-87 years); 18 patients (49%) had diverticular disease and 20 (54%) had a history of pelvic or colonic surgery. Twenty-four (65%) procedures were diagnostic, and 13 (35%) were therapeutic. The most common site of perforation was the sigmoid colon (62%); followed by the ascending colon (16%); cecum, transverse colon, and splenic flexure (11%); and rectum, anastomotic, or unknown (11%). The time to diagnosis ranged from immediate to 72 hours (29 1 hour). All patients were hospitalized; 35 (95%) underwent exploratory laparotomy, and 2 (5%) were treated conservatively. No patient died.Conclusions: Reported perforations for procedures performed in endoscopic ambulatory surgery centers occurred most frequently during diagnostic colonoscopy in older woman with a history of surgery or diverticular disease. Reported perforations in endoscopic ambulatory surgery centers were uncommon.